Healthcare Provider Details

I. General information

NPI: 1881817211
Provider Name (Legal Business Name): CONNECTICUT CHILDBIRTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 LOCUST AVE
DANBURY CT
06810-6032
US

IV. Provider business mailing address

94 LOCUST AVE
DANBURY CT
06810-6032
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-6000
  • Fax: 203-748-6771
Mailing address:
  • Phone: 203-748-6000
  • Fax: 203-748-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateCT

VIII. Authorized Official

Name: KENNETH PAUL BLAU
Title or Position: OWNER
Credential: MD
Phone: 203-748-6000